# Acute bacterial prostatitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: EAU Guidelines on Urological Infections 2023 · Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) · Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis) - Verified date: 2026-08 ## Verified against - Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) - Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis) ## Treatment metadata - Ciprofloxacin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Ofloxacin — 200 mg — oral.solid - Norfloxacin — 400 mg — oral.solid - Ceftriaxone — 1000 mg — injection - Doxycycline — 100 mg — oral.solid ## Complete treatment card ```text ACUTE BACTERIAL PROSTATITIS Sources: EAU Guidelines on Urological Infections 2023 · Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) · Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis) Review status: REVIEWED against Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt), Acute Bacterial Prostatitis - disease-level clinical article (prostatitis- full.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Acute bacterial prostatitis presents abruptly with fever, malaise, muscle aches, painful and frequent urination, hesitancy, and pelvic pain, while the chronic form is more subtle [abdominal pain · fever · malaise · muscle pain · pelvic pain · poor urinary stream · urinary frequency] - Chronic prostatitis is by definition long-standing and recurring, usually milder than the acute form but still capable of significantly hurting quality of life - Men with chronic bacterial prostatitis may also report sexual dysfunction SIGNS - what you find (4) - In the acute form the prostate is enlarged and exquisitely tender on exam, and vigorous manipulation should be avoided because it can worsen the condition - Suprapubic tenderness and fullness suggest urinary retention as a complication [abdominal pain · lower abdominal pain · urinary retention] - CVA tenderness should be checked since pyelonephritis is an important differential to exclude [abdominal pain · loin pain] - In chronic bacterial prostatitis the gland is not acutely inflamed on exam and the patient does not appear acutely ill, though some men simply carry asymptomatic bacteriuria TESTS (8) - Midstream urinalysis and urine culture are the minimum workup once acute bacterial prostatitis is suspected - If sepsis criteria are met or the patient carries major comorbidities, obtain blood cultures, lactate, a metabolic panel, and a CBC - CT or transrectal ultrasound should be considered for a prostatic abscess in immunocompromised patients or those not improving on treatment - PSA, CRP, and ESR add little value in the acute setting because they lack specificity - Gonorrhea and chlamydia testing is warranted when an STI is suspected or urethral discharge is present - Chronic prostatitis is best confirmed by a specialist using the four-glass Meares-Stamey test or the simpler two-glass pre- and post-massage urine test - The four-glass test is rarely used in practice because it is difficult for both patient and provider and rests on weak evidence - Biopsy is avoided during active infection because it risks seeding nearby organs and causes severe pain IF NOT THIS - what else fits (1) - Urethritis, prostate cancer, and urinary tract infection are also on the differential Source StatPearls "Acute Bacterial Prostatitis" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Ceftriaxone + Doxycycline Rx: Main treatment | Oral fluoroquinolone - alternative to ciprofloxacin MAIN TREATMENT - choose one 1. CIPROFLOXACIN [1st line] Adult 500 mg orally twice daily x 14-28 days Peds Adult-only condition - paediatric section not applicable AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Ciprofloxacin is a fluoroquinolone antibiotic with good penetration into prostatic tissue, making it first-line for acute bacterial prostatitis; the extended course reflects the time needed for adequate clearance of infection from that tissue. Caution A minimum 14-day duration is required for adequate prostatic tissue penetration. Refer to urology if urinary retention or prostatic abscess suspected. There is a risk of tendonitis and peripheral neuropathy. Egypt QUINOLOROX 500MG 10 F.C. TAB. EPCI > ROXXEN 10.00 EGP (1.00/unit) ECACIPROFLOX 500 MG 20 F.C. TABS. FUTURE PHARMACEUTICAL INDU... 27.00 EGP (1.35/unit) ELMODOXACIN 500MG 10 F.C.TAB. EGPI > SEA PHARM 20.00 EGP (2.00/unit) CIPROQUIN 500MG 10 F.C. TAB. UNIPHARMA 50.00 EGP (5.00/unit) CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS. ORGANOPHARMA > ORGANO 63.00 EGP (6.30/unit) CIPROFAR 500MG 10 F.C.TAB. PHARCO 69.00 EGP (6.90/unit) CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS. MASH PREMIERE 48.00 EGP HEROXACIN 500MG 10 SCORED F.C. TAB. EGPI > HERO PHARM 69.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Peds Adult-only condition - paediatric section not applicable Source Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Sepsis criteria, urinary retention, or risk factors for resistant organisms mean hospital admission and parenteral antibiotics, not the oral outpatient regimen. 3. CEFTRIAXONE [1 of 2 - GIVE ALL TOGETHER] Adult 1 g by intramuscular injection as a single dose, given together with the doxycycline course, when a sexually transmitted cause is suspected - single IM dose Peds Adult-only condition - paediatric section not applicable AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Acute Bacterial Prostatitis - StatPearls - NCBI Bookshelf (NBK459257) for the indication and the regimen shape - verbatim: "Patients who are suspected of a sexually transmitted cause of prostatitis should be treated with a single dose of intramuscular ceftriaxone followed by two weeks of doxycycline." That sentence gives no milligrams; the dose is from Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - verbatim: "IV or IM 1-2 g once or devided twice daily", 1 g vial. Why Covers Neisseria gonorrhoeae, which the fluoroquinolones on this list no longer reliably treat. Paired with doxycycline for chlamydia. Caution Suspect a sexually transmitted cause in a younger man, with urethral discharge, or with a recent new partner - test for gonorrhoea and chlamydia before or alongside treatment. Treat the partner too, or the patient is reinfected. Do not give to a patient with a history of anaphylaxis to penicillin - the cross- reactivity is low but not zero, and this is an injection given in the clinic. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP 4. DOXYCYCLINE [2 of 2 - GIVE ALL TOGETHER] Adult 100 mg orally twice daily, started with the ceftriaxone dose, when a sexually transmitted cause is suspected x 14 days Peds Adult-only condition - paediatric section not applicable Source Acute Bacterial Prostatitis - StatPearls - NCBI Bookshelf (NBK459257) for the indication and the two-week course - verbatim: "Patients who are suspected of a sexually transmitted cause of prostatitis should be treated with a single dose of intramuscular ceftriaxone followed by two weeks of doxycycline." Milligrams from Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - verbatim: "Usual dosage range: Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses", 100 mg capsules. Why Covers Chlamydia trachomatis and the other atypical organisms, and reaches the prostate. The full two weeks matters - a shorter course relapses. Caution Take with a full glass of water, sitting upright, and not at bedtime - it causes oesophageal ulceration otherwise. Causes photosensitivity. Relevant in Cairo: advise sun protection over the fortnight. Separate from antacids, iron, and dairy by two hours, which otherwise bind it and stop it being absorbed. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) ORAL FLUOROQUINOLONE - ALTERNATIVE TO CIPROFLOXACIN - choose one 5. OFLOXACIN [2nd line] Adult 200 to 400 mg every 12 hours x 2 to 4 weeks Peds Adult-only condition - paediatric section not applicable Source Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) Why One document carries both claims. The Egyptian formulary's ofloxacin monograph names prostatitis in its own indication list and states a dose: for an adult, 200 to 400 mg, one dose every 12 hours. Ofloxacin is the alternative for a patient in whom ciprofloxacin is unsuitable. The course length is the disease article's, which puts oral fluoroquinolones at 2 to 4 weeks; the formulary attaches no duration to its prostatitis indication and the citation names both documents. Caution CONTRAINDICATED where the patient is hypersensitive to ofloxacin, to any other quinolone, or to any of the product's other ingredients. The formulary names prostatitis in ofloxacin's indications but states no prostatitis- specific regimen or duration. The 200 to 400 mg every 12 hours is its usual adult dose; the 2-to-4-week course is the disease article's figure for oral fluoroquinolones in acute bacterial prostatitis. Fluoroquinolone class risks apply: tendinitis and tendon rupture, peripheral neuropathy, CNS effects, QT prolongation and disordered glucose regulation. Separate from antacids, calcium, iron, magnesium and lanthanum - they block absorption. Severe hepatic impairment (for example cirrhosis with or without ascites): maximum 400 mg/day. Sepsis, urinary retention, or risk factors for resistant organisms mean admission and parenteral therapy, not an oral course. Egypt JEDCOFLACIN 200 MG 20 F.C.TAB. JEDCO INT. CO... 43.25 EGP (2.16/unit) OFLOXIN 200MG 10 F.C.TAB. KAHIRA 21.60 EGP (2.16/unit) OFLICIN 200MG 10 F.C.TAB. MEMPHIS 24.00 EGP (2.40/unit) EPICOFLOCIN 200 MG 10 F.C.TABS. EIPICO 28.00 EGP (2.80/unit) OFLOXACIN 200MG 10 TAB SEDICO 30.00 EGP (3.00/unit) KIROLL 200MG 10 F.C. TAB. GLAXO SMITHKLINE 34.50 EGP (3.45/unit) TARIVAN 200MG 10 TAB. ALEXANDRIA 44.00 EGP (4.40/unit) TARIVID 200MG 10 F.C. TAB. SANOFI 82.00 EGP (8.20/unit) 6. NORFLOXACIN [2nd line] Adult 400 mg every 12 hours x 4 to 6 weeks Peds Adult-only condition - paediatric section not applicable Choice Sourced preference over the ofloxacin row beside it. The formulary prints a prostatitis regimen for norfloxacin by name - by mouth, 400 mg every 12 hours, the course running 4 to 6 weeks - so drug, dose and duration all come from one document. Ofloxacin's row carries the formulary's general adult dose and takes its 2-to-4-week course from the disease article instead. Ciprofloxacin remains the card's main treatment; this pair is what to use when ciprofloxacin is unsuitable. Source Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis) Why One document carries drug, dose AND duration. The Egyptian formulary's norfloxacin monograph prints an explicit prostatitis regimen in its own dosing table - by mouth, 400 mg every 12 hours, and the course runs 4 to 6 weeks - which is better sourced than the ofloxacin row beside it, whose 2-to-4-week course had to be taken from the disease article. The condition's article supplies the class-level indication: a patient who is not severely ill can go home on an oral fluoroquinolone or on Bactrim for 2 to 4 weeks, with a follow-up culture to confirm it has cleared. Seven Egyptian norfloxacin products are registered, six of them 400 mg tablets. Caution CONTRAINDICATED where the patient is hypersensitive to norfloxacin, to quinolones as a class, or to any of the product's other ingredients - and, for the tablets, where there is a past tendinitis or tendon rupture linked to a quinolone. The formulary's own Indications line for the tablets is narrower than its dosing table - it lists urinary tract infection, complicated or not, from susceptible gram-negative and gram-positive organisms. Prostatitis is named in the Dosage Regimen, not in that list, and the disease article is what recommends an oral fluoroquinolone for this condition. The formulary's course is 4 to 6 weeks and the article's is 2 to 4 weeks for oral fluoroquinolones generally; the row prints the formulary's, because that is the figure attached to prostatitis by name. Take with water on an empty stomach - 1 hour or more before food, or 2 hours after it; the same spacing applies to milk and other dairy. The instruction is the formulary's. Antacids, sucralfate and any multivitamin or supplement carrying iron, zinc, magnesium or aluminium must never be given at the same time as norfloxacin - separate them by 2 hours at least, either side of the dose. Renal impairment: at a CrCl of 30 mL/minute/1.73 m2 or below, the formulary gives 400 mg once daily. It is not to be used where there is a known aortic aneurysm, nor where the risk of one is raised - peripheral atherosclerotic vascular disease, hypertension, or an inherited disorder that alters the blood vessels. The warning is the formulary's. Fluoroquinolone class risks apply: tendinitis and tendon rupture, peripheral neuropathy, CNS effects, QT prolongation and disordered glucose regulation. Sepsis, urinary retention, or risk factors for resistant organisms mean admission and parenteral therapy, not an oral course. Egypt NORBACTIN 400MG 10 F.C.TAB. T3A PHARMA > ... 17.40 EGP (1.74/unit) NORMASH 400MG 10 F.C. TAB. MASH PREMIERE 18.00 EGP (1.80/unit) NORACIN 400MG 10 F.C.TAB. MEMPHIS 22.68 EGP (2.27/unit) EPINOR 400MG 14 TAB. EIPICO 35.00 EGP (2.50/unit) NEOFLOXIN 400MG 16 F.C. TAB. ALEXANDRIA 43.00 EGP (2.69/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)